Overwhelmed

Hello, I have paroxsymal vagally mediated atrial fibrillation. It started about 5 years ago. In the last year I have had 8 episodes that last about 3 to 4 hours. Three of those episodes have been in the last 10 days and I believe they were first triggered by the medication I took to slow my heart rate. I was taking it on a daily basis for a year and it became too much. Now my heart rate is staying in the 50s but my heart (or the vagus nerve) is so sensitive that many things will, it seems, trigger an episode of a-fib. My cardiologist suggested last year that I have a catheter ablation and I saw an EP doctor but decided against having that done. I feel good when not in a-fib. Now my cardiologist has suggested an AV node ablation and pacemaker implantation. I saw him yesterday and he told me to research it on the internet and call him to schedule the pacemaker next Thursday if I decided to do it. Frankly, there is way too much information to digest in so short a time and I really do not even know the right questions to ask. I am totally overwhelmed. I am 71 years old and have 3 heart stents, 1 previous heart attack, low thyroid untreated because of the a-fib. (I feel the thyroid med caused the original heart problems.) What should I do next?, when? Anyone have any ideas?

4 Comments

Last resort

by golden_snitch - 2013-11-29 03:11:57

Hi Stacy,

an AV-node ablation and pacemaker implant ("ablate & pace") is the last resort therapy to treat afib. It should never ever be done as the first line therapy, without having exhausted all other options. The other options are: Having tried at least a betablocker and one antiarrhythmic drug, a cardioversion (in those patients with very long episodes), and having undergone pulmonary vein isolation(s). The latter is the catheter ablation for afib which you as I understand have rejected last year.

I am really shocked to hear that your doctor is now suggesting the "ablate & pace" approach. If I were you, I'd not agree. Don't know, how many drugs you have tried, yet, to keep the afib under control. If it was just one, you could give some others a try, as for instance Flecainide or Propafenone. If you want to go for a catheter ablation, try pulmonary vein isolation and be prepared for not only one, but two or three of these catheter ablations; the success rates after just one attempt are around 60%, but with two or three attempts they get to around 80%.

Again, the AV-node ablation plus pacemaker implant should be the last resort.

Inga

A-Fib

by Roys - 2013-11-29 12:11:03

Hi Stacy
I would not be in a hurry to have a AV node ablation and a PM. I had AF for 8 years, then a PVI ( ablation ) when I was 78. You can go to the website a-fib.com by Steve Ryan and get a lot of info that would be a help to you, it was to me! I'm sure you will get more posts that will be of help to you.
Cheers Roy

Watch the a-fib

by Theknotguy - 2013-11-29 12:11:23

I am not a doctor so this is a report of what happened to me and not a medical recommendation.

I have a history of heart problems in the family. Great-grandfather - massive heart attack and died. Grandfather - massive heart attack and died. Dad was being treated for a-fib, died of cancer. Paternal grandmother has sleep apnea and heart problems. Other problems in the rest of the family too long to go into here. My heart was eventually going to get me.

I started having recorded a-fib sessions about eight years ago. There is some question that I had heart problems (undiagnosed) all my life. I was being treated medically for a-fib after a session in 2005.

I was physically very active. I volunteered at a charity where we did woodwork and moved over 2000 pounds of wood one day a week. Thought nothing of moving several hundred pounds of wood on other days. Took my son's dogs out for walks and regularly did 4 miles in the AM and over two miles in the PM. Was keeping my a-fib in check with medication.

So, one day I had just completed 3 1/2 miles of the four mile walk with the dogs when I collapsed on the trail. Woke up six days later after having an SCA (Sudden Cardiac Arrest). My heart rate was 20 when the EMT guys got there and my heart completely stopped in the ambulance on the way to the hospital. They had a hard time re-starting my heart in the ER. They had to put in a temporary PM. They also broke a rib and collapsed a lung. After four days they figured I would live and put in a permanent PM.

I won't get into the argument that your medication started your a-fib. I'm not a doctor so can't really address that question/statement. However, my a-fib was getting worse and it has to do with my family medical history. Eventually my a-fib was going to get me and it did.

Question in my mind is if your a-fib is something that was looming in your future and now your present. You'll have to discuss with your cardiologist to get the info on that.

In any case and regardless of what caused it there is a good chance your a-fib is going to get worse. Like you, my a-fib would knock me down anywhere from 4 to 24 hours. When I wasn't in a-fib I was doing better than 95% of my cardiologist's patients. However when it went bad it went really bad.

I don't like the fact I have to rely upon two machines to keep me alive - a CPAP and a PM. Still get angry about that and have a pity party (Why me?). But being alive and celebrating Thanksgiving with my family was a lot sweeter this year because I had just had an in-your-face experience of what it's like when you aren't alive. Being able to tell your loved ones that you love them and being able to give them a hug really makes up for knowing you might never have been able to do that again.

So I'd bite the bullet, get some statistics on what may be looming in your future. Others have said the PM implant isn't that big a deal. (I don't know because I was unconscious at the time.) I know it's a big step to consider using a machine to keep yourself alive but it's a lot better than being dead.

Hope this helps.

Theknotguy

Node ablation

by Maria - 2013-11-29 12:11:56

Stacy I had a pacemaker place 8 months ago. I am 65 and the device has helped my quality of life enormously. I can walk a mile and sometimes more and I seldom get out of breath.

I was afraid too. I did some research and spoke to my cardiac PM specialist who answered all of my questions. The procedure took about 2 hrs under IV sedation. I staid in the hospital overnight. I have improved in exercise tolerance and comfort.

I have not had ablation because my heart failure is due to dilated cardiomyopathy. The ablation prevents the atrial fib and the pacemaker takes over the function of the node.

Can you tell what your concerns are?

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